基于 MRI 的直肠癌新辅助放化疗适应证：一项前瞻性多中心观察研究的中期结果。

MRI-based indications for neoadjuvant radiochemotherapy in rectal carcinoma: interim results of a prospective multicenter observational study.

机构信息

General and Visceral Surgery, Vivantes Klinikum im Friedrichshain, Berlin, Germany.

出版信息

Ann Surg Oncol. 2011 Oct;18(10):2790-9. doi: 10.1245/s10434-011-1704-5. Epub 2011 Apr 21.

DOI:10.1245/s10434-011-1704-5

PMID:21509631

Abstract

BACKGROUND

This study evaluated use of circumferential resection margin status in preoperative MRI (mrCRM) as an indication for neoadjuvant radiochemotherapy (nRCT) in rectal carcinoma patients.

MATERIALS AND METHODS

In a multicenter prospective study, nRCT was given to patients with carcinoma of the middle rectum with positive mrCRM (≤1 mm), with cT3 low rectal carcinoma, and all patients with cT4 tumors. The short-term endpoints were pathologic pCRM (≤1 mm) as a strong predictor of local recurrence rate and the quality of total mesorectal excision according to the plane of surgery. These endpoints were compared in patients with and without nRCT.

RESULTS

Of 230 patients that met the inclusion criteria, 96 (41.7%) received a long course of nRCT and 134 (58.3%) were primarily operated on. The pCRM was positive in 13 of 230 (5.7%) (primarily operated on, 2 of 134 [1.5%]; after nRCT, 11 of 96 [11%]). In 1 of 134 (0.7%) case, the mrCRM was falsely negative. Patients at participating centers varied in terms of preoperative stage but not in pCRM positivity (0%-13%, P = .340). The plane of surgery was mesorectal (good) in 209 of 230 (90.9%), intramesorectal (moderate) in 16 of 230 (7%), and the muscularis propria plane (poor) in 2.2% (5 of 230).

CONCLUSIONS

Low pCRM positivity and the high quality of mesorectal excision support use of MRI-based nRCT in rectal carcinoma. nRCT was avoidable in 45% of patients with stage II and III disease without significant risk of undertreatment. Preoperative MRI thus allows identification of patients with high risk of local recurrence and use of selective nRCT.

摘要

背景

本研究评估了术前 MRI（mrCRM）中环形切缘状态的应用，作为直肠癌患者新辅助放化疗（nRCT）的指征。

材料和方法

在一项多中心前瞻性研究中，对 mrCRM 阳性（≤1mm）的中直肠癌、低位 cT3 直肠癌和所有 cT4 肿瘤患者给予 nRCT。短期终点是病理 pCRM（≤1mm），作为局部复发率的强预测指标，以及根据手术平面的全直肠系膜切除质量。在接受和不接受 nRCT 的患者中比较这些终点。

结果

符合纳入标准的 230 例患者中，96 例（41.7%）接受长疗程 nRCT，134 例（58.3%）主要手术。230 例中 pCRM 阳性 13 例（5.7%）（主要手术，134 例中 2 例[1.5%]；nRCT 后，96 例中 11 例[11%]）。在 134 例患者中，1 例（0.7%）mrCRM 假阴性。各参与中心患者术前分期不同，但 pCRM 阳性率无差异（0%-13%，P=0.340）。230 例中，209 例（90.9%）手术平面为直肠系膜（良好），16 例（7%）为直肠系膜内（中等），2.2%（5 例）为固有肌层平面（差）。